Provider Demographics
NPI:1629403027
Name:CHILDREN'S SMILE CENTER
Entity Type:Organization
Organization Name:CHILDREN'S SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-582-5439
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-0255
Mailing Address - Country:US
Mailing Address - Phone:417-582-5439
Mailing Address - Fax:417-485-5455
Practice Address - Street 1:3 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2201
Practice Address - Country:US
Practice Address - Phone:417-582-5439
Practice Address - Fax:417-485-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty